Provider Demographics
NPI:1821382276
Name:MEYER, ALEXIS LYNN BARR
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:LYNN BARR
Last Name:MEYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 W DIVISION ST
Mailing Address - Street 2:T-0215
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-6601
Mailing Address - Country:US
Mailing Address - Phone:320-253-4646
Mailing Address - Fax:320-253-4646
Practice Address - Street 1:4201 W DIVISION ST
Practice Address - Street 2:T-0215
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-6601
Practice Address - Country:US
Practice Address - Phone:320-253-4646
Practice Address - Fax:320-253-4646
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119798183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist